Abstract
BackgroundThe purpose of this study is to report the efficacy of azithromycin 1.5% eye drops in children with ocular rosacea and phlyctenular blepharokeratoconjunctivitis. This retrospective study from January 2009 to March 2010 included 16 children treated with lid hygiene plus azithromycin 1.5% eye drops (Azyter®): 3-day treatments (1 drop twice a day) every 10 days, reduced based on efficacy to one treatment every 15 days and then to one treatment per month.ResultsNineteen eyes of six boys and ten girls, aged 4 to 16 years (mean, 9.3 ± 4.0) were included. The disease was previously resistant to lid hygiene (all the patients), oral erythromycin (one patient), and intermittent topical steroids (six patients). The median duration of each phase of azithromycin treatment (i.e., three, two, and one treatments per month) was 2 months. Ocular inflammation was controlled by azithromycin alone in 15 patients. In one uncontrolled case, cyclosporine 2% eye drops was added at month 5. Bulbar conjunctival hyperemia resolved completely within 1 month in all eyes, whereas conjunctival phlyctenules and corneal inflammation took longer to improve, with a complete resolution within 3 to 10 months. Blepharitis grade decreased from 2.31 ± 0.79 to 1.50 ± 0.73. Treatment was stopped after a median of 6 months (from 4 to 10 months) without recurrence of corneoconjunctival inflammation (median follow-up without treatment, 11 months). Six cases of ocular irritation were reported, two of which led to treatment withdrawal.ConclusionAzithromycin 1.5% eye drops is an effective treatment for phlyctenular keratoconjunctivitis complicating childhood ocular rosacea.
Highlights
The purpose of this study is to report the efficacy of azithromycin 1.5% eye drops in children with ocular rosacea and phlyctenular blepharokeratoconjunctivitis
Bulbar conjunctival hyperemia and phlyctenules were present in all eyes, and corneal inflammation was noted in all eyes but one
Topical steroids and oral erythromycin were stopped in all cases
Summary
The purpose of this study is to report the efficacy of azithromycin 1.5% eye drops in children with ocular rosacea and phlyctenular blepharokeratoconjunctivitis. This retrospective study from January 2009 to March 2010 included 16 children treated with lid hygiene plus azithromycin 1.5% eye drops (AzyterW): 3-day treatments (1 drop twice a day) every 10 days, reduced based on efficacy to one treatment every 15 days and to one treatment per month. Childhood ocular rosacea is a rare but often misdiagnosed disorder associated with chronic blepharitis and, in many cases, phlyctenular keratoconjunctivitis [1]. It is alternatively named blepharokeratoconjunctivitis [2,3] or staphylococcal phlyctenular keratoconjunctivitis. The phlyctenules and corneal infiltrates are the result of a type IV cell-mediated late hypersensitivity reaction according to the Gell and Coombs' classification [5]
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